股骨、胫骨和腓骨外翻截骨治疗婴幼儿型Blount病

目的探讨经股骨、胫骨和腓骨外翻截骨治疗婴幼儿型Blount病的临床疗效。方法对7例婴幼儿型Blount病患儿行股骨、胫骨和腓骨外翻截骨,术后予以髋人字石膏固定6周。结果 7例均得到随访,时间3~16年。6例无任何膝关节疼痛不适;1例双侧胫骨内翻患儿长时间站立、行走后,左膝关节有疼痛,再次行左胫骨近端外翻截骨后畸形得到矫正,疼痛消失。结论经股骨、胫骨和腓骨外翻截骨治疗婴幼儿型Blount病,并发症少,临床疗效满意。     

组合式手术治疗儿童Perthes病

[目的]介绍内容包含改良Chiari髂骨截骨、髋关节部分滑膜切除、股骨颈钻孔减压、髂腰肌延长和股内收松解的组合式手术治疗Perthes病的技术操作关键和远期效果.[方法]对应用本术式治疗已逾3年的Perthes病儿童进行回顾随诊,通过查体和摄X线片评定治疗效果.[结果]82例得到3年以上随诊,采用自拟的从临床症状、患肢短缩、头骺覆盖率、头骺形状和关节转子间距五个选项,每项按优、良、差分别计0、1或2分的五项十分法作疗效评定,得分之和≥9分为优,7～8分为良,5～6分为可,＜5分为差.结果59例优良,优良率为75.6%.[结论]以改良Chiari术为核心的组合式手术是口前还不具有病因性治疗之Perthes病的一种较为满意的治疗选择.     

基于CT数据六轴外固定架在成人Blount病治疗中的应用

目的 探讨自主研发的基于CT数据六轴数字外固定架(Qiao-spatial frame,QSF)治疗成人Blount病的疗效.方法 回顾性分析我科2018年1月至2020年12月接受手术的Blount病患者,共7例8膝患者,男3例,女4例;年龄18～51岁,平均(36.6±11.1)岁.股骨远端外翻畸形采用内侧闭合截骨...     

股骨近端内翻截骨术治疗Perthes病的现状

般骨近端内翻截骨术的发展已有半个多世纪的历史,该技术经过长期发展,已经逐渐成熟.现已有多种手术方式及固定方式应用于Perthes病的治疗中,近年来还出现了新的微创治疗方法.随着研究的不断进展,内翻截骨术的手术原理、手术适应证逐渐清晰,在提高治疗效果、术后常见并发症如大转子过度生长及Trendelenburg症的预防性治疗方面也取得了进步,各种术式的治疗效果被大量报道.本文对股骨近端内翻截骨术治疗Perthes病的原理及其适应证、治疗现状做一综述.     

改良粗隆区截骨治疗晚期Perthes病：附26例报告

作者采用改良粗隆区内翻截骨术张力带钢丝内固定加小夹板外固定，中药外敷，治疗晚期Ｐｅｒｔｈｅｓ病２６例，结果优良率８４．６％（２２／２６），并且术后即可延长肢体的１．５ｃｍ左右。较传统的粗隆区内翻截骨加髋上石膏外固定术有明显优越性。     

Salter骨盆截骨术联合股骨近端外翻截骨术治疗严重Perthes病

目的 观察Salter骨盆截骨联合股骨近端外翻截骨术治疗严重Perthes病的疗效。方法 回顾性分析自2016-10—2019-12采用Salter骨盆截骨联合股骨近端外翻截骨术治疗的11例（12髋）严重Perthes病。结果 11例均获得随访,随访时间平均4(2.2～5.4)年。术后患儿双下肢长度差值平均为1.4(1～2)cm,髋关节活动度正常,无跛行或轻度跛行步态。术后患侧中心角、髋臼深度比、股骨头覆盖率均较术前明显改善,差异有统计学意义（P<0.05）。见表1。根据髋关节功能Mckay评价标准：优8例、良3例,优良率100%。Stulberg分型：Ⅰ型9髋,Ⅱ型3髋,优良率100%。结论 Salter骨盆截骨联合股骨近端外翻截骨术治疗严重的儿童Perthes病具有良好的临床疗效,可极大程度避免或减小髋内翻、股骨大粗隆高位,以及臀中肌无力而出现的肢体短缩,走路摇摆步态。     

改良粗隆区截骨治疗晚期Perthes病(附26例报告)

作者采用改良粗隆区内翻截骨术张力带钢丝内固定加小夹板外固定,中药外敷,治疗晚期Perthes病26例,结果优良率84.6%(22/26),并且术后即可延长肢体约1.5cm左右.较传统的粗隆区内翻截骨加髋上石膏外固定术有明显优越性.     

粗隆下旋转截骨术治疗Perthes病的疗效观察

目的：分析粗隆下旋转截骨术治疗Ｐｅｒｔｈｅｓ病的效果。方法：采用粗隆下旋转截骨的方法为３６例Ｐｅｒｔｈｅｓ病的患者（３７髋）作了治疗，患者平均年龄８．５岁（３～１４岁）。受到随访的有２４例（２５髋），平均随访５．６年（２～１０年）。根据临床表现及Ｘ线表现分别做出评估。结果：临床分组优良率占８０％，Ｘ张分组优良率占８０％。其中９岁以前的患者治疗效果较好。结论：粗隆下旋转截骨术治疗Ｐｅｒｔｈｅｓ病效果     

Blount disease: a review of the English literature

A review of the English literature on Blount disease (osteochondrosis deformans tibiae; tibia vara) revealed that two forms of the disease, infantile and adolescent, are recognized. The cause of Blount disease is probably multifactorial. Most recent evidence on the pathogenesis implicates mechanical factors. The diagnosis can be difficult in very young children and must be based on history, physical examination, and radiographic findings. A proximal tibial metaphyseal-diaphyseal angle of greater than 11 degrees should be observed carefully for the development of Blount disease. Both nonoperative and operative treatment has been used successfully.     

Ribbing disease: a case report and literature review

Ribbing disease (RD) is a rare bone dysplasia characterized by benign endosteal and periosteal new bone formation confined to the diaphysis of the long bones of the lower extremities in young adults. The etiology and optimal treatment for the disease are unknown. It is often initially diagnosed as a low-grade osteomyelitis or a bone-forming neoplasia. It may also be confused with other causes of increased bone density. The onset is usually after puberty and the most common presenting symptom is pain that does not resolve with medical treatment and sometimes is intolerable. We report the case of a 22-year old woman with clinical and radiological manifestations of RD. In spite of different medical treatment modalities, pain did not resolve and the patient consulted multiple physicians. Intramedullary reaming of the tibia was performed to relieve the severe pain. To the authors' knowledge, in this report we present a case of RD for the third time in the orthopaedic literature and also she is the second case in the English literature to undergo a definite surgical treatment modality as intramedullary reaming for the solution of her pain. Owing to the rarity of the disease we aimed to report the complete findings of our encounter with the disease and to emphasize the role of an orthopaedic surgeon in consultation and intervention for the treatment of intolerable pain which is the most important symptom of this disease.     

Cystic adventitial disease: a case report and literature review

Cystic adventitial disease (CAD) is a rare non-atherosclerotic cause of peripheral vascular disease (PVD). We describe a 54-year-old man who presented with calf claudication and catheter angiography showed the typical scallop appearances of CAD. Surgery involved resection of the diseased segment with a femoral popliteal venous bypass graft. A literature review revealed the different theories for pathogenesis, the investigation of choice being catheter angiography and the treatment excision with bypass grafting.     

Onychomatricoma: a case report with literature review

Onychomatricoma (OM) is a fibroepithelial tumor of nail matrix that occurs in the digits of both the hands and feet. This was first reported by Baran and Kint. They initially described 3 cases, all of which demonstrated a filamentous tumor of matrix tissue that resulted in a thickened funnel-shaped nail. Although apparently benign, it is subject to recurrence, and long-term follow-up is recommended because it is not known whether there is a conversion to malignancy. Even though this neoplasm was first described more than 18 years ago, there remains a dearth of case reports (currently fewer than 50) in the literature. This is a single case report and literature review. Levels of Evidence : Therapeutic, Level IV.     

胃癌合并脾包虫病1例报告并文献复习

背景与目的 包虫病在牧区是较为常见的人畜共患病,常发生在人体的肝、肺、脾、脑及腹腔等器官。而在临床上孤立性的脾囊性包虫病较为罕见,特别是合并恶性肿瘤就更为少见。目前国内外对该类合并症的研究甚少,本文对1例非疫区胃癌合并原发性脾囊性包虫病的临床表现、诊断和鉴别诊断及治疗措施等方面进行分析总结,为非疫区包虫病合并恶性肿瘤的处理提供相关的参考和思路。方法 分析本院收治的1例非疫区胃癌合并原发性脾囊性包虫病的临床表现、诊断和鉴别诊断以及治疗措施等临床病历资料,并复习相关国内外文献。结果 患者上腹部胀痛不适1个月余,经胃镜及病检证实为胃癌,彩超检查提示脾脏囊性病变,进一步经详细病史询问、查体、CT检查后诊断为局部进展期胃癌、脾脏囊性包虫病,经积极术前准备,并综合考虑肿瘤根治性及脾脏包虫的根治性处理后,进行“D₂淋巴结清扫术、根治性全胃切除、食管-空肠Roux-en-Y吻合、脾切除术、自体脾片移植术”的手术治疗,术中注意防范包虫囊肿破裂并保留了部分脾脏功能,术后病理学证实为胃癌（pT₃N₁M₀）合并脾囊性包虫病,并给予辅助化疗6周期和抗寄生虫治疗3个月。术后3个月监测外周血IgA、IgM、IgG水平均在正常范围内,说明患者免疫功能恢复正常。术后半年行CT检查时发现脾窝处有大小不等结节,考虑脾片成活组织。现患者术后15个月无肿瘤及包虫复发及腹腔播散。结论 胃癌合并原发性脾囊性包虫病在临床上是较为罕见的合并症,尤其在非疫区更为少见。在处理该类合并症时应该兼顾肿瘤和包虫治疗的特殊性,术前着重进行病史询问及完善相关检查以明确诊断;制定详细的术前治疗方案、术中相关准备及手术方案;术后应继续加强抗肿瘤及包虫的治疗和随访。     

Carcinoid heart disease: a case report and literature review

We report a patient who presented for elective exploratory laparotomy, and resection of a pelvic mass, which was thought to be ovarian carcinoma. Intraoperative transesophageal echocardiography demonstrated right-sided valvular heart lesions, which suggested the diagnosis of carcinoid syndrome before a pathologic confirmation was obtained. This article discusses the classical presentation and anesthetic management of patients with carcinoid syndrome and emphasizes the importance of proper preoperative diagnosis and careful planning if the incidence and severity of the symptoms that this condition can provoke are to be reduced.     

Ⅰ型神经纤维瘤病脊柱侧后凸并椎体完全脱位:1例报道与综述

报告1例Ⅰ型神经纤维瘤病脊柱侧后凸并椎体完全脱位患者的手术治疗方法及效果。患者,女,17岁,行手术治疗此严重畸形。经后入路在3D打印导板引导下置入椎弓根螺钉,行肋段切除胸廓成形,顶椎椎板切除神经减压后,行T5脊椎全切,最后置入双侧棒,矫正畸形、大量植骨,以重建脊柱稳定性。术中未损伤脊髓,术后患者恢复顺利, 12个月随访无复发加重的迹象。Ⅰ型神经纤维瘤病性营养不良型脊柱侧后凸畸形伴椎体完全脱位是罕见的,存在因脊柱畸形缓慢加重导致脊髓损伤的可能性。由于经济、文化等多方面的影响,常常在病情进展后才引起患者重视而进行治疗,采用后入路全脊椎截骨定制个体化减压矫形手术可能是减少术中脊髓损伤并达到令人满意结果的有效方法。     

Mesenteric Castleman's disease: case report and literature review

A 41-year-old man was discovered to have a pelvic mass during investigation for hypertension 2 years ago. Otherwise, he was asymptomatic, and abdominal magnetic resonance imaging revealed a highly vascular solid mass superior to the urinary bladder. A 131I-meta-iodobenzylguanidine whole body scan was reported as normal, which ruled out the possibility of extra-adrenal pheochromocytoma. No definitive preoperative diagnosis could be established. Surgical resection of the tumour revealed mesenteric Castleman's disease, hyaline vascular type. Such a diagnosis should be considered for any abdominal vascular mass.     

Hydatid bone disease: a case report and review of the literature

Hydatid disease may develop in almost any part of the body and can be identified with a combination of clinical history, imaging findings, and serologic results; however, the diagnosis of bone hydatidosis is primarily based on radiographic findings. Bone hydatid disease is often asymptomatic, and its diagnosis is usually made at an advanced stage when lesions have become extensive. We present a case of a 45-year-old woman who was admitted to the University Hospital, Stara Zagora, Bulgaria complaining of pain in her left tibia. Radiographs revealed an oval cyst with a diameter of 3.5 cm, located in the diaphyseal part of the tibia. The cyst was excised, and no recurrence was observed on follow-up. Functional outcome was excellent.